Mar. 23, 2014

Dr. Allen Sossan (second from left) is shown with some of the residents from a medical school in Tehran, Iran. / Norfolk Daily News

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Frances Bockholt went to the operating table at Avera Sacred Heart Hospital in Yankton convinced that an earlier back surgery needed to be fixed.

The surgeon who convinced her of that, Dr. Allen Sossan, promised that she would be free of back pain after undergoing the complex spinal procedure. Bockholt let Sossan operate on her, even though the surgeon who had done her first operation five years earlier said there was no need for the 79-year-old to have another procedure.

But rather than make her pain-free, the surgery on March 17, 2010, was the first of many. She had two additional back surgeries within a month. Then another in May and another in July when she was opened up from the front. Infections developed in her spine. The surgeries caused a hernia, which required more surgery, which created additional complications.

All told, she underwent more than a dozen surgeries. The Nebraska farm woman who had loved to garden died in agony in a Yankton nursing home. It was March 15, 2011.

In November, a Yankton jury awarded more than $930,000 to Bockholt’s children, finding that Sossan performed unnecessary surgeries on their mother. About a half-dozen other medical malpractice lawsuits against Sossan are pending, including one that’s in the process of being settled in Nebraska.

But despite the lawsuits and numerous complaints made to licensing boards in Nebraska and South Dakota by patients and doctors, no public disciplinary action ever has been taken against Sossan. He remains licensed in Nebraska and California. His license in South Dakota expired when he didn’t renew it last year, but he was never sanctioned by the state for the Bockholt surgery or for any of the others he’s accused of botching.

State laws around the country provide a screen of confidentiality to medical licensing boards. Because of the secrecy, the public has to trust that the boards are adequately policing doctors and other medical professionals. In addition, the process known as peer review, where doctors review the care provided by their fellow doctors, also is legally protected from public disclosure.

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When it came to Sossan, the secretive investigative process did more to protect him than it did his patients, according to court documents and doctors interviewed by the Argus Leader.

The Argus Leader review of Sossan found that:

■ Doctors in South Dakota, Iowa and Nebraska were so alarmed about the outcomes of his surgeries that they lodged complaints with medical boards. The boards took no action, and it’s not clear whether they even investigated the complaints. “The guy has a lot of blood on his hands,” said Dr. Daniel Wik, a pain management doctor in Norfolk, Neb., where Sossan lived and practiced. “I’m talking dead people that had things done that never should have been done.”

■ Avera Sacred Heart granted privileges to Sossan despite the fact that doctors had grave misgivings about allowing him to perform surgeries there. According to one Avera doctor, hospitals have a “backdoor communication system,” and Avera’s doctors had heard about Sossan, who had practiced at Faith Regional Hospital in Norfolk, where he eventually either lost or surrendered his privileges.

■ Tim James, a Yankton lawyer who represented Bockholt’s children and who is representing other clients against Sossan, uncovered records showing that Sossan — who then went by the name Alan Soosan — was arrested while in college in the early 1980s for felony grand theft and burglary. Sossan was arrested in Florida, according to a police report, for breaking into the biology department and stealing a test. “What made it really interesting was that it was a core requirement to get into medical school,” James said. “It’s not like he was stealing a French test.”

Sossan is a doctor of ostepathy as opposed to a medical doctor. There are differences in education and training leading to some skepticism of osteopaths. But both are licensed through the same board in South Dakota.

Refusals to comment on doctor

His Norfolk phone number was disconnected, and efforts to reach him were unsuccessful. Sossan’s Facebook page indicates that he’s living in Iran, his native country. He lived there until he was 13 before coming to the United States with his family, according to a deposition. He did not reply to a Facebook message seeking an interview.

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The Argus Leader contacted the law firm that represented him in the Bockholt case in an attempt to get an email address for Sossan, but the firm did not respond.

Nebraska officials refused to say how many complaints had been filed against Sossan since he first was licensed there in 2004. That information, said Mike Grutsch, the state’s licensing program manager for investigations, is closed by state statute.

The South Dakota Board of Medical & Osteopathic Examiners also declined to say how many complaints had been filed against Sossan. The board issued a statement saying Sossan no longer has a license to practice in the state because he failed to renew it on March 1, 2013.

“The license no longer existed after March 1,” the statement said. “As to any complaint which was received after that date, there would be no license to investigate or take action.”

The hospitals where Sossan practiced either didn’t return calls or declined to release dates during which Sossan had privileges and the reasons for why he lost his privileges to practice. Those hospitals included Faith Regional and the SurgiCenter in Norfolk, and Avera Sacred Heart and Lewis & Clark Specialty Hospital in Yankton. Lewis & Clark, where Sossan was a shareholder, also is a defendant with Sossan in some lawsuits.

Lindsey Meyers, a spokeswoman for the Avera system based in Sioux Falls, said in an email: “Avera does not discuss our policy of granting privileges, or the process. This is confidential to ensure full and open discussion during the process.”

Colleagues startled by Sossan's actions

By the time he operated on Frances Bockholt in Yankton, Sossan was known to orthopedic surgeons, anesthesiologists and other doctors in the region between Omaha and Sioux Falls.

Dr. Quentin Durward, a neurosurgeon in Dakota Dunes, had what he called a “baffling” experience with one of Sossan’s patients several years ago.

She was a young woman who had hurt her back in a work accident and was seeing Durward for a second opinion. She was scheduled to undergo surgery by Sossan the next week. Three of her vertebrae would be cemented together. Durward said it was an unusual surgery for someone so young.

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After reviewing X-ray and MRI images of the woman’s spine, Durward said he could find no reason to do the surgery.

“I was puzzled why he would be ordering an operation for a fracture when there was no fracture,” Durward said.

But something else had stood out on the patient: She had a medical bandage on her hand. When Durward asked about the bandage, the young woman told him that Sossan had performed carpal tunnel surgery on her wrist. She was scheduled to get the other wrist done at the same time she had back surgery.

Durward said he reviewed the tests for carpal tunnel — a pinching of the nerves in the wrist — and they were negative. The woman also said she had no symptoms but agreed to get the surgery after Sossan told her she needed it.

Durward reported Sossan to the Nebraska medical board. He also considered reporting it to police, because he deemed the unnecessary carpal tunnel surgery an assault. The person who took his complaint at the board, he said, urged him not to report it to police.

“The comment was, ‘No, no, don’t do that. If you call the police, we’ll never get anything accomplished,’ ” he said.

Eight months later, he received word from the board that it was dropping his complaint.

“I know at least two surgeons who reported this guy’s work, and similarly got replies back that, ‘We looked into it, and we’re not going to do anything,’” he said.

Since then, Durward estimates that he’s seen dozens of former Sossan patients.

“I was really irritated by the response I got from the Nebraska board,” he said. “Because I really thought that, left unchecked, he was going to hurt a lot of people.”

One patient who claims to have been hurt by Sossan is Dan Meyer, a 57-year-old farmer who underwent spine surgery in 2005 — one of the first patients Sossan operated on after moving to Norfolk from New York. Following the surgery, a fragment of cadaver bone implanted during the procedure came loose and lodged in the bottom of his spine, resulting in nerve damage.

Today, Meyer spends a lot of time in a wheelchair. He was taking 60 milligrams of morphine three times a day, but thanks to the recent addition of a spinal cord stimulator, which disrupts signals to his brain, he has reduced his daily morphine intake to 60 milligrams once a day.

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“In my opinion, he’s a ...,” Meyer says before trailing off. “I am a Christian, also,” he resumes, “It’s very hard for me to think about him and be a Christian, also.”

Meyer said he filed a complaint with the Nebraska licensing board in 2006. Nothing came of the complaint.

Meyer wasn’t alone. In a deposition in one of the pending lawsuits against Sossan, Dr. Robert Suga, a surgeon at the Orthopedic Institute in Sioux Falls, was asked whether he was familiar with Sossan.

“I am familiar with him by his reputation, and I have seen other patients that he has operated on, and I have seen other things that he has done,” Suga replied. “I’ve seen patients that have contacted the state medical society for various procedures that were done that were not indicated. So I’m familiar with his practice.”

Later in the deposition, Suga accused Sossan of doing procedures on the plaintiff, Yankton resident TerryAnn Brewer, out of financial gain rather than for Brewer’s benefit.

“So to me, he is just generating bills and income for himself, and really with no rationale,” Suga said.

Suga declined to be interviewed for this story.

Wik, the pain management doctor, worked with Sossan at Faith Regional in Norfolk. He and other doctors complained to hospital management about Sossan, but their complaints weren’t heeded. Wik thinks money had something to do with that. Orthopedic surgeons and spine surgeons in particular are some of the highest profit generators for hospitals.

“Money in medicine talks, especially if you’re a hospital or surgery center,” he said.

But eventually, Sossan lost or relinquished his privileges at Faith Regional and the SurgiCenter of Norfolk.

Sossan heads north to Yankton

Sixty miles due north was Yankton, which, like Norfolk, had a hospital and a surgical center, Lewis & Clark Specialty Hospital. Sossan became a shareholder in Lewis & Clark, according to court records.

The doctors on Avera Sacred Heart’s management executive committee initially were opposed to granting Sossan privileges to perform surgery at their facility. They had heard enough stories that they didn’t want him.

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They delayed granting him privileges, but after about a year, Sossan threatened to sue. Matt Michels, a lawyer for Avera Sacred Heart, told the executive committee that Sossan probably would prevail in court under laws that bar organizations from restraining trade. The problem for the executive committee was this: Nebraska’s licensing board had not taken action against Sossan’s license, and Faith Regional had not reported adverse activity, so Avera didn’t have grounds to reject his request for credentials.

Michels, who also serves as lieutenant governor, declined to comment specifically on Sossan, saying he is restricted by attorney-client privilege and the privilege granted by peer review.

James, the Yankton lawyer, criticized Avera and Lewis & Clark for allowing Sossan to practice in the community.

“At some point, if you’re determining privileges in Yankton, South Dakota, you have to ask yourself, why doesn’t he have privileges in Norfolk, Nebraska?” he said.

After Frances Bockholt died, her children asked Dr. Lars Aanning in Yankton to review her medical records to determine a cause of death. After reviewing her files, Aanning said he was appalled by what he saw. “I looked at them and I thought, boy, this is fricking crazy,” he said.

Aanning said he filed a complaint with the South Dakota Board of Medical and Osteopathic Examiners, and he helped the family file a complaint with the South Dakota Foundation for Medical Care, a peer review organization whose mission is to improve the quality of Medicare. In August 2011, the family received a letter signed by the organization’s medical director, Dr. Stephan Schroeder, which found no fault with the medical care Frances Bockholt received from Sossan.

In an interview, Schroeder said he signed the letter but didn’t conduct the review. That was done by a physician reviewer whose identity is anonymous, in keeping with the peer review system.

“It’s the opinion of a reviewer,” Schroeder said. “My name goes on the letter to protect the identity of the reviewer.”

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Dead woman's family sues

The family hired James, who filed suit against Sossan in February 2012.

“I didn’t want to see anybody else get harmed by this person,” said Timothy Bockholt, Frances’ son. “Basically, it was for our mother.”

During his investigation into Sossan, James uncovered the criminal records in Florida. James said he thinks Sossan changed the spelling of his last name from Soosan — the spelling used by his siblings — to Sossan in order to hide the criminal records.

James obtained Sossan’s application to practice medicine in Nebraska. On the application, Sossan did not list the felony. But when James tried to get the license he’d submitted to practice in South Dakota, the board here moved to quash his subpoena. South Dakota’s board, James said, thought it was more important to protect Sossan’s privacy than Sossan’s patients.

“They’ve tried to make this out like there’s some doubt when there just isn’t any,” James said. “It’s just so clear cut. It baffles me. It’s sad. It should terrify every patient. We have a system that’s like the health care lottery. Except, if you get the bad guy, you’re dead. Really, you’re guessing at who’s going to take care of your health, because the board won’t tell you.”

In its statement to the Argus Leader, the board defended its decision to oppose the release of Sossan’s application.

“The South Dakota Legislature wrote a confidentiality statute for physicians, and the South Dakota Supreme Court has said this statute is to be read broadly when applying it, so the board is obligated to protect the confidentiality of applications and investigations for physicians,” the statement said.

Regardless, James and the family won the jury verdict in November. Since then, more lawsuits have been filed, and James has heard from almost two dozen people who say they or a loved one was harmed by Sossan.

“To date, our medical board, the entity charged with protecting the public, has not disclosed a single relevant fact about Sossan’s history or the many complaints against him and did absolutely nothing to stop him,” James said. “Worse yet, because of peer review, the board’s failures can’t even be evaluated to find out what went wrong and prevent future injury. The secrecy of peer review results in a crap shoot for patients every time they walk into a doctor’s office.”